Yoga Breathing for Health

Almost everyone including people with asthma or COPD (Chronic Pulmonary
Obstructive Breathing) can benefit from breathing slowly and exhaling
more completely. Benefits of slow breathing and longer exhalation are
many. To wit: Greater control over breathing; reduction in shortness of
breath and breathing discomfort; increase in physical and mental
relaxation; relaxed breathing and more open airways which can transport
air in and out more effectively.

By breathing slowly and lengthening exhalation relative to inhalation,
lungs can be more effectively emptied out and filled, old and stale
excess air eliminated and hyperventilation (over breathing) and
hyperinflation of lungs (enlargement of lungs due to surplus air) 1 can
be modified. Actually, benefits of the breathing pattern of slow
breathing and longer exhalation are too numerous to list here.

You are likely to hear from yoga teachers who teach a breath-centered
practice such statements as, “Exhalation is the key,” “Take care of
the exhalation and inhalation will take care of itself,” or simply the
instruction, “Exhaaale!” encouraging you to prolong your exhalation.
These instructions may seem very counter intuitive because most people
instinctively believe inhalation is most important. Yogis from ancient
times practiced conscious and controlled breathing, called “pranayama.”
They extensively worked on strengthening abdominal muscles in order to
exhale more fully. Their morning breathing practices to a large extent
consisted of gentle, slow and long exhalation and inhalation and only to
a small extent that of vigorous exhalation and inhalation. In this
article, we will discuss a number of gentle and slow breathing
techniques.

Try them and see which one's work best for you.

Pranayama and breath coordinated yoga postures (asanas) can help us
to slow our breathing and lengthen our exhalation. I have personally
practiced some time or the other all the techniques discussed in this
article. They have helped me to reduce shortness of breath and increase
my stamina and exercise tolerance.

Developmental Work for the Breathing Exercises

Maintain breath awareness for most part of the day. Stay conscious of
your breathing whether you experience any breathing difficulty or not.
Try to maintain breath awareness while walking or performing other
exercises and activities. Develop a keen sense of breath awareness at
all times, whether resting or exerting

Walk every day

Perform gentle stretches and upper body exercises including trunk
flexion several times a week.

Become an expert of Pursed-Lip Breathing (PLB): PLB is well known
to build positive air pressure in the airways in order to exhale more
effectively and completely. Instructions for PLB are widely available in
the respiratory literature. To instruct briefly, inhale through your
nose, purse your lips like you would while whistling or kissing and
exhale maintaining consistent flow and pressure of breath. The technique
of pursed lips can be applied to many of the exhalation techniques
described in this article. The ancient technique of chanting “Om” in
India is a type of PLB technique.

Don't strain your breath! Rest in between as long, and as many times
as needed. Don't force your breath. Follow the mantra, “Coax it. Don't
force it.!” Stay within your comfort zone at all times.

Start with one or two techniques. Gradually increase the length of
the breath and the number of repetitions of each technique.

Some techniques may feel more comfortable and natural to you than the
others. Adopt the ones you like for your daily practice.

Know your limits. Some days you may not be able to do as much as you
did the other day. Still another day, you may find a technique difficult
which was easy the day before. Know what you can do that day and how far
you can challenge yourself that day by recognizing when you are
approaching your exertion limit, and slowing down or stopping before you
develop severe shortness of breath.

The sixteen (16) ways to cultivate slow breathing and lengthening
exhalation are divided into following categories:

Predominantly Physical techniques

Predominantly Mental Techniques

Breath Manipulation Techniques

Breath Vocalization

Alternate Nostril breathing Techniques

Instrumental

Don't take the categories literally or mutually exclusive. They are
loose “baskets” to hold somewhat similar techniques in order to make it
easier to put our arms around them.

Breath coordinated spinal movement (Asana): Utilize postures
which facilitate exhalation such as forward bending, lateral flexion and
spinal twist because they make it easier to exhale more fully. Examples:

In the standing, sitting or kneeling position, while exhaling slowly
bend forward

In the sitting position, press the floor or hold the
chair seat with one hand while exhaling raise the other arm and bend
laterally

In seated or reclining position, while exhaling perform an
abdominal twist. Select low intensity stretches to avoid excessive work
for the muscles. Perform several repetitions of the same posture slowly
and smoothly. Progressively lengthen your exhalation during these
repetitions.

By coordinating and manipulating the speed of breathing and movement
into and out of a posture you can progressively lengthen your
exhalation. Example: Sit on a chair with arms by your side. Press hands
on both sides of the seat. While elongating your spine, inhale to
of your lungs. While exhaling, start bending forward. Adjust the speed
of forward bending movement so it lasts as long as your exhalation does.
The extension of exhalation, in parts, depends on how slowly you bend
forward, how slowly you exhale while bending forward and how far forward
you bending.

Relaxation Pose (Shavasana): Relax and exhale! Exhale and relax!
Relaxation is the master skill for breathing retraining. Shavasna, the
reclining relaxation pose is excellent for relaxing and deepening the
breathing and extending exhalation. When you are relaxed, breathing
automatically gets slow and soft, diaphragmatic breathing restored and
all stress related breathing irregularities are reduced. Several times a
day, take a few minutes each time to relax physically and mentally. With
calm and quiet mind, relax the whole body. Imagine you are in a
peaceful, quiet and relaxing place. Relax the entire face including the
jaw, neck and shoulders and then the rest of the body. Continue to relax
and exhale. With each exhalation, relax even more than before.

Predominantly Mental Techniques:

Forming intention (Sankalpa) for longer exhalation: Intention is
well known to inspire action and affect the outcome. Therefore, form the
intention of slowing your breathing and lengthening your exhalation. Be
patient and relaxed about your intention. You can't change your
breathing in a hurry. Keeping your new intention at the back of your
mind let the exhalation extend. When you remain calm and relaxed and
mindful of your intention, breathing is likely to become soft and slow,
and exhalation might begin to “stretch” longer than inhalation. Try not
to inhale deeply or fully. Allow the exhalation to extend longer without
straining your breath.

Tracking the breath flow (Sakshi): Bring your mind to breathing.
Don't judge it, simply witness it. Track the flow of the breath during
inhalation and exhalation without tension, rush or anxiety. While
inhaling, move your attention downward from chest to abdomen. While
exhaling, move your attention upward from pelvis to solar plexus. In
other words, track the downward flow of breath as you inhale and upward
flow of breath as you exhale.

According to the Viniyoga tradition and in my own experience as a person
with COPD, tracking inhalation downward and exhalation upward is
enjoyable and comfortable. However, some people are more comfortable
with tracking inhalation upward and exhalation downward. Whichever works
better for you is the one you should practice. There is a cute saying in
yoga circles, “Breath flows where attention goes.” So it all works out.
All you need to do is to track the breath flow. Paying attention to the
direction of the breath flowing upward and downward in the ribcage and
abdomen is likely to relax you, slow the breathing and lengthen the
exhalation.

Direct Breath Manipulation Techniques

Silently count the length of each breath (Shvasa-prashvasa
sankhya): Simply counting silently in head while breathing
automatically slows and relaxes the breathing for most people. Example:
While inhaling, silently count in your head by saying “one thousand one”
“one thousand two” “one thousand three” “one thousand four.” While
exhaling also silently count, “one thousand one” “one thousand two” “one
thousand three” “one thousand four.” As you continue, increase your
count for exhalation, for example, up to 1005 or 1006 while still
keeping the inhalation up to 1004. Maintain the ratio of inhalation and
exhalation as 1 to 1.5 or 1 to 2. Does keeping a count while breathing
make you tense? Do you try very hard to maintain the same ratio or try
to lengthen the breath too early and too hard?

It is important to be patient and relaxed about breathing.
If counting makes you tense in trying to keep the same number then let
go of the count. Use your judgment to maintain the exhalation longer
than inhalation (refer to “Inhale partially, exhale fully.”). All you
have to do is to inhale less fully and exhale more fully. If you feel
all right about breath counting, adopt the practice in your daily life.
Wherever and whenever you remember to do it, start counting (1001, 1002,
1003 and so on) as you inhale and exhale. You may do this while sitting,
standing, walking, working, performing an activity or exercising.

Count only the exhalations (Prashvasa ganana): Inhale briefly.
Exhale and towards the end of exhalation say silently or out loud,
“One!” Again, inhale briefly. Exhale and as you near the end of that
exhalation say, “Two!” Repeat and with each subsequent exhalation, count
the next number “three,” “four” and so on until you complete ten
exhalations in this manner. To increase the sense of relaxation and
lengthen exhalation, each time as you exhale, let your body become loose
and limp and say the number in a soothing and soft tone such as,
“Onnne!” “Twooo!” “Threee!” and count up to 10 exhalations. If time
permits, repeat another round of ten exhalations.

Inhale partially, exhale fully (Viloma visham vritti 1): When you
inhale, simply stop inhaling or 2/3rd or 3/4th of way, but exhale
more fully without forcing or straining your breath. Progress gradually
in favor of longer exhalation. Maintain the ratio of 1: 1.5 or 1: 2
between inhalation and exhalation. In other words, keep the exhalation
one and one-half time or twice longer than the inhalation. Example: 4
second inhale and 6-8 seconds exhale or 5 seconds inhale and 7-10
seconds exhale.

Inhale passively, exhale actively (Viloma visham vritti 2):
Inhale passively by simply allowing the inhalation process to occur, but
while exhaling, mildly engage the abdominal muscles by gently pulling
the lower belly towards the back. It is gentle “forced expiration.” Use
only gentle force and mild contraction of abdominal muscles while
pulling in the navel towards the back.

Segmental Exhalation (Viloma krama): Inhale in one continuous
stretch but split your exhalation in two segments. Here are the
instructions: Inhale in one continuous breath. Then, slightly contract
your lower belly, that is, pull it in towards the back from pelvis to
the navel and exhale the way. Pause for a second or two and then
contract your belly from navel up to the solar plexus while finishing
the other half of your exhalation. When you get really good at 2-segment
exhalation, you may 3-segment exhalation. For example: Inhale! Pause for
a 1-2 seconds and then exhale 1/3rd while contracting perineum to
pelvis. Pause for 1-2 second and exhale another 1/3rd while contracting
from pelvis to the navel. Pause for 1-2 seconds and complete the last
1/3rd of the exhalation while contracting the abdomen from navel to the
solar plexus.

Body locus breath (Yoga nidra breathing): True, we all breathe
in and out through nose and occasionally the mouth. But in this exercise
we IMAGINE breathing in and out through other body locations. Here is
the exercise in imagination in order to increase the exhalation: Each
time as you inhale, imagine the in-breath entering through the crown of
your head and ending in the heart region. Each time as you exhale,
imagine the out breath starting from the heart region going all the way
down and exiting through the toes and soles of the feet. In short,
imagine inhaling through the crown of the head to the heart and exhaling
from the heart to the toes and soles of the feet. This exercise can be
done while sitting or lying down, though most relaxing when you are
lying down.

Whisper chanting: Begin singing these four consonants in a soft
whisper: “Sa, ta, na, ma,” “Sa, ta, na, ma,” “Sa, ta, na, ma,” “Sa, ta,
na, ma,” and so on as long as your exhalation lasts without straining
your breath. As you begin inhaling, continue singing these four
consonants in soft whisper for a brief inhalation (filling in one half
or two thirds of your lungs). Thus, form a continuous cycle of singing
the consonants in whispering breath, inhaling and exhaling without
straining your breath. The moment you feel any sign of fatigue or
strained breath, stop and take rest. Whispering is unique because you
can continue singing during exhalation as well as inhalation. Your
exhalation should remain longer than inhalation. For example, repeat sa,
ta, na, ma 4-5 times during inhalation and 6-8 times during exhalation.

Alternate Nostril Breathing Techniques

Partially closed nostril alternate nostril breathing
(Anuloma-viloma variation): Alternate nostril breathing should be done
on a day when the nostrils are not blocked. In the traditional alternate
nostril breathing, we keep one nostril fully open for breathing and the
other fully closed. But in this variation of alternate nostril
breathing, instead of keeping the nostril completely open, we partially
close. By partially closing the nostril we create a “valve” for
breathing in and out.
Technique for “valved” nostril breathing: Close one nostril completely
by applying the pressure of thumb or fingers on the flap of the nostril
(the lower portion of the nose). Partially close the other nostril by
gently pressing the cartilage in the upper nose with your fingers or
thumb.

Thus, the valved nostril remains partly open for exhalation or
inhalation and thus helps you to control the flow and the volume of the
breath. By crafting a valve in the nostril, you can further increase the
differential between inhalation and exhalation. You can close inhaling
nostril with little more pressure and a little less pressure at the
exhaling nostril. In this way, you can further affect the flow and
amount of air you exhale and inhale. At any rate, make sure you
manipulate the valve in such a way that exhalation works out to be
longer than inhalation.

Exhaling through the dominant nostril (Nadi shodhana): Several
times a day, there is a shift in breath flow from one nostril to the
other. As a result of this shift one nostril registers greater flow of
breath compared to the other. This phenomenon is refered to as,
“ultradian rhythm of the nasal cycle.”2 Incidentally, the shift in nasal
cycle is also associated with the shift in the dominance of the right or
left brain hemisphere. To identify which nostril is dominant at a given
time, close one nostril and exhale against the back of the hand. Now
repeat the process with the other nostril. Which nostril appears to
exhale more fully? Utilize the dominant nostril for exhalation and
passive nostril for inhalation for just a few breaths.

Instrumental

Exhalation Props (Prashvasa sopashraya): There are a number of
aids we can use to extend exhalation. To wit: woodwind instruments such
as flute; harmonica; whistle; whistling, etc.

End Notes

For a comprehensive discussion of the physiology of overinflated
lungs and hyperinflation, refer to Deane Hillsman, M.D website on COPD
self-help at http://www.sierrabiotech.com/bt_copd_home.html

Changes in the relative fight-left brain hemispheric activity occurs
several times a day and the hemispheric changes appear to be associated
with the right left nostril air flow, referred to as “nasal cycle.” At
any given time, one nostril is more open and has the greater amount of
air flow which may partly be due to congestion and decongestion of the
veins lining the nasal mucosa. This alternation of right and left
hemisphere dominance and changes in the air flow in the right and left
nostrils occur at varying intervals in the individuals ranging from
about half an hour to 5 hours with peaks between 90-200 minutes during
waking. This phenomenon also occurs during night at varying time
intervals for individuals (some of the results of Google search for
“Ultradian rhythm of nasal cycle”).

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Vijai Sharma, PhD

Vijai Sharma, PhD, Certified yoga therapist and yoga teacher.
Vijai, a life long student of yoga and disciple of Swami Rama of the Himalayan cave monastery completed his yoga teacher and yoga therapist training with Gary Kraftsow at the American Viniyoga Institute (AVI). Vijai specializes in mind-body medicine, particularly, alleviation of anxiety, depression, anger, pain, stress, breathing and relationship issues. His personal practice of yoga postures, breath training, mental-physical relaxation, mindfulness and meditation has helped him to live a vibrant quality of life in spite of the lung and heart impairment.
He is on the faculty of AVI yoga therapist training. Vijai has developed two exercise DVDs and companion workbooks, "Stretching and Breathing Exercises Adapted for People with Severe COPD," and "Stretching and Breathing for COPD for All Levels of Fitness." His 600+ articles on emotional stressors, positive mental attitudes, positive health behaviors and coping with chronic illness are posted at www.mindpub.com
Cell: (423) 596-2750 Evening: (510) 452-0364
Vijaisharma@att.net
Vijai Sharma, PhD AVI Certified Yoga Therapist and Yoga TeacherDirector, Yoga for COPD & Yoga Just For You
4167 Balfour Avenue Oakland, CA 94610